Medicare local coverage
Medicare coverage for Botulinum Toxin Injections (LCD)
5 Medicare Administrative Contractors publish a local coverage determination (LCD) for Botulinum Toxin Injections. The snapshot lists 6 LCD records: 6 active.
An LCD applies only in the jurisdiction of the contractor that wrote it. Two contractors can cover the same service with different criteria, documentation requirements and covered diagnoses, so check the LCD from the contractor that processes your claims.
LCDs by contractor
| Contractor | LCD | Status | Last updated |
|---|---|---|---|
CGS Administrators, LLCMAC - Part A, MAC - Part B | L39857 | Active | Jan 21, 2026 |
Noridian Healthcare Solutions, LLCMAC - Part A, MAC - Part B | L35172 | Active | Dec 29, 2025 |
Noridian Healthcare Solutions, LLCMAC - Part A, MAC - Part B | L35170 | Active | Dec 29, 2025 |
Palmetto GBAMAC - Part A, MAC - Part B | L39836 | Active | Jan 20, 2026 |
Wellpoint FederalMAC - Part A, MAC - Part B | L39832 | Active | Jul 15, 2026 |
WPS Insurance CorporationMAC - Part A, MAC - Part B | L39909 | Active | Mar 26, 2026 |
An LCD marked Future has been finalized and is in its notice period; it applies from the effective date shown. LCD IDs link to the record on cms.gov.
Billing and coding articles
The codes live in the billing and coding article that goes with each LCD: the CPT and HCPCS codes the policy applies to, the ICD-10 codes that support medical necessity, and any modifier or documentation rules.
- A57185Noridian Healthcare Solutions, LLCUpdated Apr 3, 2026
- A57186Noridian Healthcare Solutions, LLCUpdated Aug 10, 2026
- A59707Wellpoint FederalUpdated Jul 15, 2026
- A59714Palmetto GBAUpdated Apr 2, 2026
- A59809WPS Insurance CorporationUpdated Apr 29, 2026
CMS also lists 5 response-to-comments articles for this topic, where contractors answer public comments on the proposed LCD: A59986, A60349, A60352, A60365, A60366.
Check claim lines against Medicare coverage
Coverage Check tells you whether a claim's diagnoses support Medicare LCD or NCD coverage for each procedure line, and shows the policy and CMS source behind each answer.
Related LCD topics
- Botulinum Toxin Type A & Type B
- Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound
- Botulinum Toxins
- Epidural Steroid Injections for Pain Management
- Hyaluronic Acid Injections for Knee Osteoarthritis
- Injections - Tendon, Ligament, and Ganglion Cyst
All Medicare LCD topics · National coverage determinations · Payer policies by payer
Source: CMS Medicare Coverage Database, via the public CMS Coverage API, snapshot Oct 25, 2026. LCDs change between snapshots; confirm the version in effect for your date of service on cms.gov before billing.